ANGELINA JOLIE’s BRCA GENE, PROPHYLACTIC MASTECTOMIES AND RECONSTRUCTION
Recently it was reported that Angelina had undergone a bilateral prophylactic mastectomy for a history of BRCA positive genetics.
The BRCA 1 and 2 genes are genetic and if one possesses these genes, the risk for breast cancer and ovarian cancer is increased significantly. Preventative mastectomies as well ass oophorectomies (removal of ovaries) are recommended before one develops these cancers. Detecting this gene has become more common. This is likely because of the increased awareness and increased testing. Although there are no guidelines on when the breast should be removed, many breast surgeons believe that it should be a minimum of 10 years prior to any first degree relative developing breast cancer in the past.
If the mastectomies are prophylactic, one becomes a better candidate for a nipple sparing mastectomy. In this operation, the breast is removed through an incision in the breast fold, leaving the native nipple intact. The cosmetic outcome is generally better than a skin sparing traditional mastectomy. Angelina Jolie had the breast tissue in the nipple tested for cancer and this was negative. There is no universal agreement as to whether or not this is necessary, just as there is still breast tissue left on the skin of the breast after the mastectomy.
Angelina also had a sentinel lymph node biopsy done in case there was cancer present in the breast that was not detected. That way the lymph nodes could be treated (removed) if there was cancer present in them.
Angelina wisely went with a two stage reconstruction: tissue expander and mesh followed by a second surgery in which the tissue expander was removed and an implant placed. In her case, she had an anatomically shaped implant placed as opposed to a round silicone implant. This is an excellent choice for a smaller woman desiring a large B or smaller chest. She may have had some fat injections as well.
Angelina received the current care available to most patients who have a breast surgeon and a well trained plastic surgeon. This is not special care that is available in California or any place in particular.